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Sex Differences in Fall Frequency, Risk Factors, and Outcomes in Parkinson's Disease: A Cross-Sectional Analysis
Joaquin A Vizcarra1,2, Kat Hefter2,3, David-Erick Lafontant4
1Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Movement Disorders Clinical Practice
|May 7, 2026
Summary
Women with Parkinson's disease (PD) experience more frequent falls and injuries, even with milder symptoms. This highlights the need for sex-specific prevention strategies to manage fall risk in PD progression.
Area of Science:
- Neurology
- Gerontology
- Movement Disorders
Background:
- Female sex is a known risk factor for falls in Parkinson's disease (PD).
- However, specific patterns of falls and their outcomes in relation to sex remain unclear.
- Understanding these differences is crucial for targeted interventions.
Purpose of the Study:
- To compare fall risk and outcomes between sexes across Parkinson's disease (PD), prodromal alpha-synucleinopathy (PAS), and healthy controls (HC).
- To estimate fall frequency as PD progresses.
- To determine how sex influences fall risk and associated outcomes.
Main Methods:
- Analysis of fall outcomes from the Parkinson's Progression Markers Initiative (PPMI) cohort.
- Estimation of yearly rates of rare and frequent falls based on time since diagnosis.
- Classification of PD participants into never, rare, or frequent fallers.
- Assessment of clinical measures across motor, cognitive, behavioral, sleep, and autonomic domains.
- Evaluation of outcomes including injuries and healthcare utilization.
- Application of regression models adjusted for age, sex, and disease duration with Benjamini-Hochberg correction.
Main Results:
- Parkinson's disease (PD) participants exhibited higher odds of falling compared to prodromal alpha-synucleinopathy (PAS) and healthy controls (HC).
- Females with PD and PAS showed increased odds of injuries and fractures, including hip and upper-extremity fractures.
- Within the PD group, fall frequency escalated with disease duration and was consistently higher in females, despite their milder clinical profiles.
- Fall occurrence was also higher in females across different stages of the Neuronal Synuclein Disease-Integrated Staging System (NSD-ISS).
Conclusions:
- Fall frequency and severity increase with Parkinson's disease (PD) duration and disease stage (NSD-ISS).
- Female participants with PD face a higher risk of falls and injuries, even with less severe clinical symptoms.
- These findings underscore the importance of developing and implementing sex-specific fall prevention strategies for individuals with PD.
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